| NPI | 1215610506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2025050590) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 2023031553) |
| Enumeration Date | 2023-08-11 |
| Last Update Date | 2025-11-28 |